Returns to Public Agricultural Expenditure Under Uncertainty

A vast literature has investigated the returns to investment in agriculture research and generally found extremely high rates of return. These results suggest policymakers would do well to maintain or increase resource allocation to public agricultural research. Remarkably little attention has been paid, however, to the issue of how best to allocate public agricultural research funding between competing research areas and organizations. This paper considers the relative returns to alternative uses of public agricultural research funds committed to the agricultural experiment stations of 10 western states of the United States over the years 1967-91. A model of expected utility maximization subject to risk is presented with comparative analysis. After establishing empirically that the mean variance analysis would be an inappropriate method to solving the problem, a stochastic dominance testing method is employed to identify dominated and undominated research categories and state agricultural experiment stations. The mean variance analysis also is used to evaluate whether research productivity has been increasing or decreasing over time, and to establish which among the western states hold absolute advantage in particular research areas

Metabolic syndrome and insulin resistance in migraine

Metabolic syndrome is associated with migraine but there is no study comparing the characteristics of migraine with and without metabolic syndrome from Southeast Asia. This study was therefore undertaken to compare the clinical characteristics of migraine in patients with and without metabolic syndrome and insulin resistance. 135 consecutive patients with migraine diagnosed on the basis of International Headache Society criteria were subjected to clinical evaluation as per fixed protocol. Headache severity, frequency and functional disability were recorded. Metabolic syndrome was diagnosed as per National Cholesterol Education Programme: Adult Treatment Panel III and International Diabetic Federation criteria. Insulin resistance was calculated by homeostases model assessment. Their age ranged between 14 and 61 years and 108 were females. Metabolic syndrome was present in 31.9% patients and only 13 were obese. Insulin resistance was present in 11.1%. Metabolic syndrome was correlated with age, gender, number of triggers, years of headache and duration of migraine attacks. Insulin resistance correlated with duration of migraine attacks. From this study, it can be concluded that metabolic syndrome was present in 31.9% of the migraineurs which was mainly in elderly who had longer duration of headache and multiple triggers

Determination of Satisfaction Index as a tool in evaluation of CME Program

Continuing Medical Education is an indispensable part of physician's learning. Welldesigned program based on andragogy principles can enhance learning by motivatingthe learner and providing platform to encourage self directed learning. The presentstudy aimed to explore the impact of program “NAMS-AIIMS Regional Symposiumon Sleep Medicine” in changing the behavior and attitude of participants using“Satisfaction Index” and descriptive analysis of responses as evaluation tools forprogram effectiveness. This descriptive cross sectional study captured the response ofparticipants through a pre-tested and validated questionnaire administered at the end ofsymposium. The result showed almost equal sex distribution (M: F- 27: 34) withmajority being UG students (86%). Reliability of data showed Cronbach's Alpha of0.98 indicating high reliability. Satisfaction index (SI) calculated as per WHOEducational Handbook for Health Personnel showed highest satisfaction for conduciveenvironment of symposium (87.87 %) followed by provision for time to seekclarifications (87.21%), provision of appropriate Learning Resource material (85.90%) and handling of critical comments by organizers (85.57%). Descriptive analysisshowed majority responses as highly positive to our questionnaire with suggestions formore such activity, inclusion of clinical cases and other aspects of practical relevance.Key words : evaluation, program, satisfaction index, Kirkpatrick Model, studentsatisfaction, adult learning, Knowles Theory

Exploring the scope of sleep medicine in current medical teaching and utility of CD Based Learning Resource Material

Background: Only recently health professionals have started recognizing sleep disorders as one of the commonest cause of morbidity. Only in the last 50 years have scientists and physicians attempted a systematic study of the physiology and disorders of sleep. The situation is changing in India too. About a decade ago the sleep medicine started developing but remained in the domain of Pulmonary Medicine. Through various societies, meetings, workshops it has now percolated to physiologists, neurologists, psychiatrists and allied specialists. However, there is still a gap in the awareness about sleep and its disorders among health professionals. Limited information is available regarding sleep education in current medical curriculum in India and globally.Aims: (i) To find out the existence of a course or module on sleep medicine in any of Government medical colleges in India. (ii) To explore feasibility of using Learning Resource Material (LRM) on CDs for Continuing Medical Education.Methods: As an outcome of Sleep Symposium held at National Academy of Medical Sciences (India) conference at AIIMS, Jodhpur, a survey was carried out among 100 Government Medical Colleges in India along with Resource Material consisting of didactic teaching material distributed through Compact Disc (CD) to explore utility of the method.Results: Response rate from medical colleges was 41 %. Ninety five percent of medical colleges denied of having any structured course or module on sleep medicine. Fifty percent felt that such module should be included for both UG and PG while 70 % agreed for PG only. Regarding cost effective delivery methods for the content of such a module, majority responded in favour for an online or DVD based with one of the content experts as a resource person with his physical presence. All respondent were highly satisfied by the content of CD.Conclusion: Sleep education is almost non-existent in most of medical schools in India. Survey elicited average response from academic community. However, sleep education has been perceived by 70 % participants to be included in PG curriculum. The content of PowerPoint presentations was considered highly satisfying and using multi-modal technology for sleep education is regarded to be an effective delivery method by majority. It can be concluded that there is felt but unmet need of a course on sleep medicine in our existing medical curriculum using information technology.Key words: Sleep module, CD based CME, Continuing Education, sleep education

Optimizing the Effectiveness of CME Program: NAMS Experience

purposeful learning require strong basis of principles of adult learning along with a sound knowledge and requisite skills in both psychology as well as technology of medical education. Assessing effectiveness of a CME program is as important as the organization of learning activities and delivery of academic program as these may provide further directions for enhancing the efficacy of the CME delivery system.Objective: (i) The purpose of this study was to investigate the effectiveness of well planned and conducted CME program in terms of enhancing knowledge and competence of the participants. (ii) To explore if the gain in knowledge and competence, if any, can be attributed to the interactive design of the educational process.Methods: The study was conducted during NAMS-AIIMS Regional Symposium on Sleep Medicine at AIIMS, Jodhpur as part of NAMSCON 2013. After explaining the objectives of the study to the participants and assurance of confidentiality, a validated and pre-tested questionnaire consisting of 30 multiple choice, single response questions, was administered to 103 participants. Following intervention consisting of didactic lectures by experts in different aspects of sleep medicine, interactive sessions and problem triggered sessions consisting of clinical data, participants were re-administered post test questions which were, however, different from pre-test but had similar difficulty level.Result: The response rate of participants was 89%. Pre-intervention scores were 11.76 ± 4.4, with only 26 % of participants achieving an arbitrary pass score of 50 %. Comparison of paired score of participants who attempted both pre and post tests (n=59) showed improvement from 12.1 ±4.6 to 18.3 ± 3.8 which was significant (p <0.05). 84.7 % of participants secured above pre decided 50% score. The mean increase in the score was 6.2 with 95% CIs 4.8; 7.5 (P <0.001). Higher gain in knowledge and competencies is attributed to intense interactive involvement of participants during the problem triggered sessions, feedback provided during interaction and system of reward and incentive introduced at time of sessions. The study concludes that well designed educational intervention based on the principles of adult learning brings positive gain in the knowledge and enhances competence of the participants.Key words : Pre-post test, retrospective post-pre test, program evaluation, evaluation of educational intervention

Evaluation of susceptibility testing methods for polymyxin

SummaryBackgroundThe widespread resistance in Gram-negative bacteria has necessitated evaluation of the use of older antimicrobials such as polymyxins. In the present study we evaluated the different susceptibility testing methods for polymyxins B and E against Gram-negative bacteria using the new Clinical and Laboratory Standards Institute (CLSI) guidelines.MethodsThe susceptibility of 281 multidrug-resistant (MDR) Gram-negative bacteria (GNB) to polymyxin B was evaluated, comparing broth microdilution (BMD; reference method), agar dilution, E-test, and disk diffusion. Disk diffusion testing of polymyxin B was also performed against 723 MDR GNB.ResultsTwenty-four of 281 (8.5%) isolates were found to be resistant to polymyxin B by the reference BMD method. The rates of very major errors for agar dilution and E-test (for polymyxin B) were 0.7% and 1%, respectively, and those for disk diffusion (for polymyxin B and polymyxin E) were 1% and 0.7%, respectively. For the 257 isolates found sensitive by reference BMD, the rates of major errors by agar dilution and E-test (for polymyxin B) were 2.4% and 0%, respectively, and those for disk diffusion (polymyxin B and polymyxin E) were 0% and 0.7%, respectively. Twenty-six (3.6%) of the 723 Gram-negative isolates were resistant to polymyxin B by disk diffusion.ConclusionThe E-test and agar dilution methods showed good concordance with BMD. The disk diffusion method can be useful for initial screening in diagnostic laboratories